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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701517
Report Date: 03/28/2022
Date Signed: 03/28/2022 03:11:30 PM

Document Has Been Signed on 03/28/2022 03:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PINE VALLEY PRESCHOOLFACILITY NUMBER:
376701517
ADMINISTRATOR:CRYSTAL KREMENSKYFACILITY TYPE:
850
ADDRESS:7454 PINE BOULEVARDTELEPHONE:
(619) 473-9022
CITY:PINE VALLEYSTATE: CAZIP CODE:
91962
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Crystal KrermenskyTIME COMPLETED:
01:43 PM
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On 3/28/2022 at 1:00pm, Licensing Program Analyst (LPA), Martha Malane met with licensee representative, Crystal Kremensky via telephone for an Office Meeting. The purpose of today's meeting was to review pending documents listed on the LIC184C - Notice of Incomplete Application checklist.

LPA reviewed and discussed the pending documents in detail with licensee representative, Crystal Kremensky.

A copy of this report was provided to licensee representative via email. Licensee representative was advised that acknowledgement of receipt of the report is to be received within twenty-four hours.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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